Abstract

<b>Background:</b> Renal dysfunction is associated with adverse cardiovascular outcomes in patients with heart failure (HF), but its impact on patients with heart failure with preserved ejection fraction (HFpEF) remains unclear. <b>Methods:</b> 3,392 subjects of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial were assigned to two groups by estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m² or 30-59 ml/min/1.73 m². The outcomes, including all-cause death, cardiovascular death and HF hospitalization, were examined by multivariable cox models. <b>Results:</b> Over a median follow-up of 3.4 ± 1.7 years, a total of 524 all-cause deaths, 334 cardiovascular deaths and 440 HF hospitalizations occurred. Compared with patients with eGFR ≥ 60 ml/min/1.73 m², those with eGFR 30-59 ml/min/1.73 m² were associated with an increased risk of the all-cause death [adjusted hazard ratio (HR), 1.47; 95% confidence interval (CI), 1.24-1.76; <i>P</i> &lt; 0.001], cardiovascular death (adjusted HR, 1.53; 95% CI: 1.23-1.91; <i>p</i> &lt; 0.001), and HF hospitalization (adjusted HR: 1.21; 95% CI: 1.00-1.47; <i>p</i> = 0.049) after multivariable adjustment for potential confounders. <b>Conclusions:</b> eGFR 30-59 ml/min/1.73 m² was related to an increased risk of all-cause death, cardiovascular death and HF hospitalization in HFpEF patients.